Healthcare Provider Details

I. General information

NPI: 1194863449
Provider Name (Legal Business Name): MICHAEL CLARK BAGLEY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E EGBERT ST SUITE 100
BRIGHTON CO
80601-2475
US

IV. Provider business mailing address

1860 E EGBERT ST SUITE 100
BRIGHTON CO
80601-2475
US

V. Phone/Fax

Practice location:
  • Phone: 303-655-3003
  • Fax: 303-655-3005
Mailing address:
  • Phone: 303-655-3003
  • Fax: 303-655-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR45154
License Number StateCO

VIII. Authorized Official

Name: MICHAEL C. BAGLEY
Title or Position: D.O.
Credential: D.O.
Phone: 303-655-3003